Outcome of Patients with Broken Transsyndesotic Fixation Screws

Introduction: Ankle fractures are very common. Injuries of syndesmosis occur in 11–20% of malleolar fractures. In these cases, trans-syndesmotic screw fixation (TSSF) is required. Many surgeons prefer to remove the TSSF at 8-12 weeks postoperatively although this practice is lacking sufficient evidence. In many instances the screws are broken at the time of removal. The aim of this study is to investigate the clinical outcome of failed TSSF
Methods: 123 patients with TSSF were treated in our center between 2005-2015. Out of them 21 patients with 22 failed TSSF were identified.
Radiographs were studied for the zone of screw breakage, fracture classification, presence of arthritic changes and tibiofibular synostosis (TS). Clinical follow up was studied for final function and range of motion. Minimum follow-up was 1 year (range 1-10years). 
Results: all fracture excluding one involved displacement of two malleoli or more. 17 patients treated with two TSSFS and 5 with one. In 5 cases 4.5mm were used while the rest were treated with 3.5 screws. In 2 cases screws were removed in <2months, 14 in 3-4 month 3 months. 9 screws were broken in the fibula, 11 screws in the tibiofibular joint gap, 3 in the tibia and 3 screws failed in more than 2 places. Residual medial joint space widening was found in 4 patients and residual lateral widening in 1. TS were found in 7 patients. Overt arthritic changes were found in 3 patients. 3 patients found with limited range of motion, one patient with wound infection, one patient with hardware loosening.
Conclusion: in ankle fractures, TSSF failure may indicate a less innocent outcome as previously thought. Further, postpective investigation is required to establish this postulation